Akathisia is a condition characterized by a feeling of inner restlessness and an uncontrollable urge to move. This neurological and movement disorder makes it difficult for individuals to remain still, often leading to significant distress.
Understanding Akathisia
Akathisia manifests as a profound sensation of unease or internal agitation, creating a compelling need to move. Individuals often describe feeling an intense restlessness, a desire to “jump out of their skin,” or an inability to relax. This inner turmoil can be accompanied by visible physical movements, particularly affecting the lower limbs. Common physical signs include repetitive crossing and uncrossing of legs, constant swinging of legs while seated, shifting weight from one foot to another, rocking back and forth, or pacing.
Primary Causes of Akathisia
Akathisia is primarily recognized as a side effect of certain medications, with antipsychotic drugs being the most frequent cause. Both first-generation (typical) and second-generation (atypical) antipsychotics can induce akathisia, with older first-generation drugs posing a higher risk. The condition often emerges soon after beginning a new antipsychotic medication or following an increase in dosage.
Beyond antipsychotics, other classes of medications can also trigger akathisia. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are known to cause this side effect, though less commonly than antipsychotics. Antiemetics, which are drugs used to treat nausea and vomiting, have also been linked to akathisia. Other medications, including certain calcium channel blockers and drugs for vertigo, may also contribute to its development. Akathisia can also occur as a withdrawal effect when certain medications are reduced in dosage or discontinued.
Medical Approaches to Managing Akathisia
Managing akathisia often begins with adjusting the medication regimen that caused the symptoms. A healthcare provider may consider lowering the dose of the offending medication or switching to an alternative drug less likely to induce akathisia. This approach is a primary step in addressing medication-induced akathisia.
Several medications can be prescribed to alleviate akathisia symptoms. Beta-blockers, such as propranolol, are frequently considered a first-line treatment due to their effectiveness in reducing restlessness. Benzodiazepines, like clonazepam, may also be used to help manage symptoms, though they are generally recommended for short-term use due to potential for dependence. Anticholinergic medications, such as benztropine, can be helpful. Other options that have shown some benefit include low-dose mirtazapine, an antidepressant, and vitamin B6.
Non-Medical Strategies for Relief
Alongside medical interventions, several non-pharmacological strategies can help individuals cope with akathisia symptoms. Engaging in light physical activity, such as walking or stretching, can provide temporary relief from the urge to move. Gentle movement can help dissipate some of the internal restlessness.
Relaxation techniques are also beneficial for managing the distress associated with akathisia. Practices like deep breathing exercises, mindfulness, or meditation can help calm the nervous system and reduce feelings of tension and anxiety. Maintaining a comfortable and quiet environment, free from excessive stimuli, may further aid in reducing agitation. Avoiding stimulants, such as caffeine, can also prevent exacerbating restlessness. These supportive measures can complement medical treatment by providing a sense of control and comfort.
Working with Your Healthcare Provider
Open and clear communication with your healthcare provider is important when experiencing akathisia. It is advisable to describe your symptoms comprehensively, including when they started and any changes in intensity. Providing a detailed history of all current and recently changed medications, including dosages, can help your doctor identify potential causes.
Never adjust or discontinue any prescribed medication without consulting your doctor, as this can lead to worsening symptoms or withdrawal effects. Your healthcare provider will assess your condition, potentially using tools like the Barnes Akathisia Rating Scale, and work with you to develop a safe and effective treatment plan. This collaborative approach ensures that your treatment is tailored to your specific needs and that any underlying causes are properly addressed.